According to the Genworth 2021 Cost of Care Survey, the average monthly cost of assisted living is $4,500. This fee may increase due to the price of additional services, such as help with activities of daily living (ADLs) ⓘActivities of daily living, also called ADLs, are activities related to necessary personal care. These include bathing, dressing, toileting, eating, walking, and transferring in and out of a bed or chair., like bathing or dressing.
Because assisted living facilities are regulated on the state level, the cost and scope of services will vary widely based on where you live. For example, Genworth reported the average cost of assisted living in Florida is about $4,000 per month; in Oregon, it’s $5,045; and in Alaska, the average cost of assisted living is more than $6,000 per month.
Assisted living pricing structures
Our research found that most assisted living facilities provide residents a base fee for room and board and then add additional monthly fees based on the level of care each resident needs. In most cases, the more care you or a care recipient needs, the more expensive assisted living will be.
Nearly all assisted living facilities will require an assessment prior to, or shortly after, a resident’s move-in date. The purpose of the assessment is to provide each resident with a level of care appropriate for their needs, and to ensure that the assisted living facility can provide that care. Because assisted living is regulated on the state level, the forms used for these assessments will vary from state to state and sometimes even from facility to facility. Assisted living resident assessment forms used in Rhode Island and Oklahoma show that residents are typically evaluated on the following criteria:
- Medications taken and the degree to which the resident needs assistance with medication administration
- Any medical conditions or diagnoses, as well as supports needed for those conditions, such as a continuous positive airway pressure (CPAP) machine for sleep apnea
- Degree to which the resident needs help with ADLs, such as bathing, toileting, and personal hygiene
- Level of physical activity, including the resident’s ability to walk without assistance and transfer to and from bed on their own
- Behavioral information, including cognitive function
- Risk factors, such as violent behavior or wandering outside
- Special diets or preferences
After this evaluation, Carla Payne, a certified life care manager and founder of Aging Care Matters in Wake Forest, North Carolina, shared that a base rate of $2,500 can easily balloon to $5,000 or more per month. “A community may start with a base rate of $2,500 for just the room with meals included,” she said, “but after an assessment by the nurse, the person is deemed to need medication management, which adds money to the base fee. Or the person is incontinent and needs assistance in the bathroom, which again adds money.”
Here’s how those fees break down in two facilities we researched:
- One facility we researched in Lafayette, Colorado, offered a base fee of $4,500 for a one-bedroom apartment and $4,000 for a studio. In addition to the apartment, this fee included Wi-Fi and cable, housekeeping, laundry, and three meals and three snacks per day. This facility then had three levels of care, priced at an additional $700 per month, $1,100 per month, and $1,700 per month. Someone who needed level one care would have minimal needs, such as help with medication management and one or two ADLs. Someone in level three care would need the highest level of care the facility offered, which might include escorts to communal spaces, help with toileting, and transferring from bed to a chair and back again. At this assisted living facility, a resident with a one-bedroom apartment who needed a high level of care could pay as much as $6,200 per month.
- A facility we researched in Grand Rapids, Michigan, had three all-inclusive pricing tiers. Each tier included a studio apartment, Wi-Fi and cable, housekeeping, laundry, three meals and snacks per day, and any personal care services the resident needed. In this facility, the monthly fee for the first tier, or the lowest level of care, was $5,100 per month. The third tier, or the highest level of care, was $6,700 per month.
In most facilities, residents are regularly assessed, and their level of care may change based on that assessment. Older adults and their caregivers should know the cost of assisted living will increase along with the resident’s needs.
Assisted living hidden fees
Before signing a lease with an assisted living facility, be sure you read the contract’s fine print. Gerontologist Christina Peoples, founder and lead educator at GeroWhat?!, shared that overlooking important parts of the assisted living contract, combined with a lack of transparency from staff, can result in residents experiencing “anxiety, discharge for nonpayment, and distrust in staff.” To avoid these issues, read the contract closely and consider having an elder law attorney review it before you sign. Also, ask questions about fees that could increase the monthly assisted living payment.
Many assisted living facilities require new residents to pay an initial community fee. This one-time fee, often used to prepare a unit for the next occupant, is usually nonrefundable and can range from $1,000–$5,000. One facility we researched in Columbus, Ohio, asked for a $1,500 community fee. Another facility in Greenville, South Carolina, asked for a $2,500 community fee.
Assisted living facilities often increase rates on an annual basis. Payne estimated annual increases to be between 4% and in some cases as high as 10%. That kind of increase can make a significant difference in your budget. Before signing an agreement with an assisted living facility, ask about annual rent increases.
Fees for increased level of care
Even if a care recipient starts assisted living at the lowest level of care, a person’s needs will usually increase as they age. Events, like unexpected illnesses or falls, can increase the need for care, which will in turn increase your monthly costs. Be sure to ask the facilities you tour about the fees associated with every level of care. Also, if a person’s needs progress to the point the facility can no longer provide the level of care the resident requires, what steps will the facility take to help you find care you need and can afford?
Memory care fees
The National Center for Assisted Living (NCAL) reported that 42% of assisted living residents are living with Alzheimer’s disease or another form of dementia.
When a person’s dementia progresses to the point they can no longer carry out most ADLs or are at risk of wandering outside the facility, it’s time for memory care. A switch from assisted living to a memory care unit in the same facility can significantly increase monthly fees. For reference, the average monthly cost of memory care is $6,160.
That’s about $1,600 more each month than the cost of assisted living alone.